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Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature. 自行注射阿曲库铵致死:一例罕见病例及文献综述。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-03-01 Epub Date: 2024-10-04 DOI: 10.1097/PAF.0000000000000985
Darshan Galoria, Srushti Shukla, Arijit Datta, Abhishek Das, Dhara Goswami, Pradip Rana, Preeti Tiwari

Abstract: Atracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.

摘要:苯磺酸阿曲库铵是一种非去极化骨骼肌松弛剂,于 1980 年首次问世。它用于气管插管。它可在手术或机械通气时引起肌肉松弛。当人们考虑自杀时,他们会使用周围环境中的药物,但通常不会使用注射用肌肉松弛剂,因为这种药物并不常见。全世界很少有关于使用肌肉松弛剂自杀的研究报告。有这样一个案例:一名 34 岁的男性护理人员在普外科手术室工作,早上被发现躺在房间的床上不省人事,床边放着一支空注射器。他被送到急诊科时已被宣布死亡。法医进行了尸检,在外部检查中,发现左侧肘窝有一处针刺伤。全身未发现其他外部伤痕。毒物分析报告显示,在玻璃体、血液、尿液以及穿刺部位和静脉下方的皮肤中发现了鸦片苷。此外,对犯罪现场发现的空注射器进行的毒理学分析表明,其中含有阿曲库铵,证实受害人注射了致命剂量的阿曲库铵。
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引用次数: 0
Association Between Cardiovascular Disease and Death by Anaphylaxis: A 20-Year Retrospective Study in Queensland, Australia. 心血管疾病与过敏性休克死亡之间的关系:澳大利亚昆士兰州一项为期 20 年的回顾性研究。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-03-01 Epub Date: 2024-07-16 DOI: 10.1097/PAF.0000000000000972
Jack Garland, Peter Smith, Rexson Tse, Beng Ong, Nathan Milne

Abstract: Despite its severity, anaphylaxis carries a low mortality rate of less than 1%, making the cohort seen in the forensic pathology setting a small and unique subset of the majority of cases of anaphylaxis in the community. Clinically, cardiovascular disease has been recognized as a risk factor for fatal anaphylaxis; however, there is scant forensic pathology research investigating this risk factor, whereas autopsy textbooks emphasize physical respiratory changes seen in the broader clinical cohort. This 20-year retrospective study examined all fatal anaphylactic deaths in the state of Queensland, Australia, to document the underlying disease of the cases, tryptase levels, triggers, and postmortem findings. Our study found that cardiovascular disease was prevalent in 83.3% of cases of fatal anaphylaxis. Although asthma was prevalent in food-related fatal anaphylaxis (60%) in our cohort, it was poorly represented overall (28%), in contrast to clinical research. Additionally, only 43% of cases showed respiratory changes that were greater than mild. Our findings emphasize the difference between the clinical and postmortem anaphylaxis cohorts, and provide autopsy evidence of a potential role of cardiovascular disease in fatal anaphylaxis.

摘要:尽管过敏性休克很严重,但其死亡率却很低,不到 1%,这使得法医病理学环境中的群组成为社区中大多数过敏性休克病例的一个小而独特的子集。临床上,心血管疾病已被认为是致命性过敏性休克的一个危险因素;然而,法医病理学对这一危险因素的研究却很少,而尸检教科书则强调在更广泛的临床人群中看到的呼吸系统物理变化。这项为期 20 年的回顾性研究调查了澳大利亚昆士兰州所有致命的过敏性死亡病例,记录了病例的潜在疾病、胰蛋白酶水平、诱因和尸检结果。我们的研究发现,在 83.3% 的过敏性休克死亡病例中,普遍患有心血管疾病。虽然在我们的队列中,哮喘在与食物相关的致命性过敏性休克中很常见(60%),但在总体上却很少见(28%),这与临床研究结果形成了鲜明对比。此外,只有 43% 的病例表现出轻度以上的呼吸系统变化。我们的研究结果强调了临床和尸检过敏性休克队列之间的差异,并为心血管疾病在致命性过敏性休克中的潜在作用提供了尸检证据。
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引用次数: 0
Penetrating Crossbow Injury to the Head: A Case of Suicide. 头部穿透性弩伤:一个自杀案例。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-03-01 Epub Date: 2024-11-05 DOI: 10.1097/PAF.0000000000000986
Dorethea Maria Joubert
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引用次数: 0
Drug Trends in the Teenage Postmortem Population From 2017 to 2021. 2017 至 2021 年青少年死后人群的毒品趋势。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-03-01 Epub Date: 2024-07-22 DOI: 10.1097/PAF.0000000000000977
Jennifer L Swatek, Brianna L Peterson

Abstract: The teenage population is highly vulnerable to drug exposure, use, and misuse due to the physical and emotional development that occurs at those ages. Social influences, like the isolation experienced during the COVID-19 pandemic and social media, can exacerbate this vulnerability. To better understand the potential impact of these influences on teenage drug use, postmortem results reported by a large reference laboratory from 2017 to 2021 corresponding to the teenage population were evaluated for various drugs of misuse. These data revealed a marked increase (385%) in reported fentanyl cases and a 13% increase in positivity rate. Methamphetamine- and cocaine-positive cases also increased 126% and 54%, with a net percent positivity of +0.6% and -0.5%, respectively. Conversely, heroin showed a consistent decline in reported cases (67%) and a net decrease of 1.0% in positivity rate. In addition to commonly misused drugs, trends for other substances that are prevalent in social media and therefore may disproportionally impact teens, MDMA/MDA, mitragynine, and diphenhydramine, were also assessed. A discussion of drug-related social media trends is presented to provide additional context for the data and trends reported herein, ultimately creating a framework through which social influences on teenage drug use can be better understood.

摘要:由于青少年正处于身体和情感发育阶段,因此极易接触、使用和滥用毒品。社会影响(如 COVID-19 大流行期间所经历的隔离和社交媒体)会加剧这种脆弱性。为了更好地了解这些影响因素对青少年药物使用的潜在影响,我们对一家大型参考实验室报告的 2017 年至 2021 年青少年群体的尸检结果进行了评估,以了解各种滥用药物的情况。这些数据显示,报告的芬太尼病例明显增加(385%),阳性率增加了 13%。甲基苯丙胺和可卡因阳性病例也分别增加了 126% 和 54%,净阳性率分别为 +0.6% 和 -0.5%。相反,海洛因报告病例持续下降(67%),阳性率净下降 1.0%。除了常见的滥用药物外,还评估了在社交媒体中普遍存在并因此可能对青少年产生过大影响的其他药物(MDMA/MDA、mitragynine 和苯海拉明)的趋势。本文对与毒品有关的社交媒体趋势进行了讨论,为本文报告的数据和趋势提供了更多背景信息,最终建立了一个框架,通过该框架可以更好地了解社会对青少年吸毒的影响。
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引用次数: 0
Cardiac Myxoma With Postmortem Computed Tomography and Postmortem Examination Correlation. 心肌瘤与死后计算机断层扫描和尸检的相关性
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-03-01 Epub Date: 2024-05-23 DOI: 10.1097/PAF.0000000000000955
Yan Bo Dora Chan, Rexson Tse, Melissa Thompson
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引用次数: 0
Conduction System Hamartoma: Autopsy Case Series. 传导系统 Hamartoma:尸检病例系列。
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-03-01 Epub Date: 2024-09-03 DOI: 10.1097/PAF.0000000000000981
Beyza Keskin Ozturk, Eylul Gun

Abstract: Conduction system hamartoma is a benign hamartomatous lesion arising from Purkinje and Purkinje-like cells of the heart. We aimed to investigate the cases that we detected during postmortem histopathological examination. The histopathology reports of the cases autopsied between 2012 and 2022 were reviewed retrospectively. The cases were evaluated in terms of histopathological features, demographic data, autopsy findings, causes of death, microbiological results, and accompanying cardiac anomalies. There was a total of 4 cases. The female-to-male ratio was 3/1. The mean age of the cases was 5.8 months. The heart weight was found within the normal range when evaluated according to age and gender. Microscopy revealed sharply demarcated cell groups or layers with histiocyte-like cells with foamy cytoplasm. Congenital heart disease and lung infection were given as causes of death in all cases. The lesion, which was previously called histiocytoid cardiomyopathy and many different names, is known as "conduction system hamartoma" in the latest World Health Organization classification (5th edition). Being aware of this entity that causes fatal arrhythmias and sudden cardiac deaths is important for pathologists. Autopsy findings should be evaluated by taking extra samples from the heart if necessary, especially in suspected cases below 2 years of age.

摘要:传导系统火腿肠瘤是一种良性火腿肠瘤病变,由心脏的浦肯野细胞和浦肯野样细胞引起。我们旨在调查在尸检组织病理学检查中发现的病例。我们回顾性审查了 2012 年至 2022 年期间尸检病例的组织病理学报告。我们对病例的组织病理学特征、人口统计学数据、尸检结果、死亡原因、微生物学结果以及伴随的心脏畸形进行了评估。共有 4 个病例。女性和男性的比例为 3/1。病例的平均年龄为 5.8 个月。根据年龄和性别进行评估后发现,心脏重量在正常范围内。显微镜检查发现细胞群或细胞层分界清晰,细胞呈组织细胞样,胞浆呈泡沫状。所有病例的死亡原因均为先天性心脏病和肺部感染。这种病变以前被称为组织细胞样心肌病(histiocytoid cardiomyopathy),也有许多不同的名称,在世界卫生组织最新的分类(第五版)中被称为 "传导系统火腿肠瘤"(conduction system hamartoma)。对于病理学家来说,认识到这种可导致致命性心律失常和心脏性猝死的疾病非常重要。必要时,尤其是对 2 岁以下的疑似病例,应通过从心脏采集额外样本来评估尸检结果。
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引用次数: 0
Bladder Wash as an Alternative Postmortem Toxicology Specimen: Forensic Pathologists' Perspectives.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-02-27 DOI: 10.1097/PAF.0000000000001034
Luke N Rodda, Kylie E Candela, Amy P Hart, Ellen G Moffatt, Sue Pearring, Karen S Scott

Abstract: In postmortem forensic investigations, where the bladder is voided or dehydrated prior to autopsy, it is possible to wash the bladder with saline to collect the resulting "bladder wash" and any residual urine for toxicological analysis. Although this method is not yet commonplace or standard, a recent study has demonstrated that bladder wash is an effective alternative specimen in postmortem forensic toxicology. The current study aimed to assess forensic pathologists' opinions on the use of bladder wash samples both before and after reviewing bladder wash toxicological data. An online survey was distributed to forensic pathologists from NAME, and responses were analyzed to identify any shifts in perceptions after data presentation. The findings revealed that most forensic pathologists recognized the benefits of bladder wash collection and analysis as well as its usefulness in determining the cause and manner of death, with noticeable changes in perspective following exposure to supporting data. This study highlights the potential value of standardizing the easy and accessible collection of bladder wash for postmortem toxicological analysis, thereby providing forensic pathologists with invaluable information when other biological specimens are unavailable.

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引用次数: 0
Flecainide Intoxication: An Unusual Case of Suicide.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-02-21 DOI: 10.1097/PAF.0000000000001026
Shumin Fan, Keith Norman Norton

Abstract: Flecainide is among the most prescribed antiarrhythmic medications and is used to effectively treat recurrent arrhythmia and maintain normal sinus rhythm by acting as a sodium channel blocker. However, its potent effects and narrow therapeutic window pose increasing risks of flecainide intoxication and ensuing morbidity and mortality. Here we report an unusual case of suicide by intentional flecainide overdose. This case demonstrates the importance of early recognition and treatment in avoiding the adverse consequences of flecainide intoxication, and it also demonstrates the importance of appropriate use and safe storage of flecainide.

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引用次数: 0
Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source: Case Study in Iatrogenic Infection and Our Approach.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-02-19 DOI: 10.1097/PAF.0000000000001027
Thomas Herb, Jeffrey Jentzen, Carl Schmidt

Abstract: Iatrogenic infections of cadaveric bone grafts have led to 2 outbreaks of Mycobacterium tuberculosis (Mtb) infection in the United States that have resulted in multiple fatalities. We report a case of one of the bone graft recipients from the 2023 outbreak. A 57-year-old immunocompromised female with a history of renal failure status post 3 kidney transplants underwent a laminectomy with a cadaveric bone graft due to spinal stenosis. She was later hospitalized with diffuse lymphadenopathy and surgical site purulent ulceration. The workup included positive cultures for Mtb. Despite appropriate therapy, the patient died in the hospital. Autopsy findings included purulent discharge from the surgical site, medullary abscesses of one of the transplanted kidneys, diffuse pinpoint areas of softening in the liver, and lung congestion. Histology of the liver and right lung demonstrated loose granulomas with abundant acid-fast organisms. The kidney abscesses were due to Candida species infection. Overall, findings were consistent with disseminated Mtb infection. Additional investigation found similar infections in recipients of the same bone graft source. We compare the Mtb outbreaks to similar outbreaks, including cases of fungal meningitis due to steroid injections, and discuss our approach and strategy in cases of iatrogenic infection.

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引用次数: 0
Preventing Fentanyl-Related Overdose Deaths with Naloxone-A Medical Examiner Study.
IF 1 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2025-02-13 DOI: 10.1097/PAF.0000000000001028
Gabriel D Alexander, Pamela A Ferreira, Stephanie A Dean, Russell T Alexander

Abstract: An epidemic of fentanyl overdose deaths has led to community naloxone use to save lives, and it has been suggested that businesses face legal liability for failing to provide naloxone. This study reviewed Maryland fentanyl-related overdose deaths in 2022. A death was considered preventable by widespread availability and use of naloxone in the following circumstances: a witnessed arrest, a person suffering an overdose found within 30 minutes of last being known alive, a person found unresponsive who showed potential to be resuscitated by emergency medical services, or the person being "found dead" in a public area such that a reasonable opportunity existed for someone else to find the decedent earlier and administer naloxone before death occurred. Of the 2047 overdose deaths in the study, 13.5% were deemed possibly preventable, and 2.7% were found such that a business could have possibly provided naloxone. The preventable overdoses were most commonly found by a "close contact" (family, friend, boy/girlfriend, and room/housemate) in a residence. A targeted effort to educate and supply naloxone to people who use drugs and their close contacts offers the best chance of reducing fentanyl overdose deaths. Mandating all businesses to carry naloxone is not supported by this study.

{"title":"Preventing Fentanyl-Related Overdose Deaths with Naloxone-A Medical Examiner Study.","authors":"Gabriel D Alexander, Pamela A Ferreira, Stephanie A Dean, Russell T Alexander","doi":"10.1097/PAF.0000000000001028","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001028","url":null,"abstract":"<p><strong>Abstract: </strong>An epidemic of fentanyl overdose deaths has led to community naloxone use to save lives, and it has been suggested that businesses face legal liability for failing to provide naloxone. This study reviewed Maryland fentanyl-related overdose deaths in 2022. A death was considered preventable by widespread availability and use of naloxone in the following circumstances: a witnessed arrest, a person suffering an overdose found within 30 minutes of last being known alive, a person found unresponsive who showed potential to be resuscitated by emergency medical services, or the person being \"found dead\" in a public area such that a reasonable opportunity existed for someone else to find the decedent earlier and administer naloxone before death occurred. Of the 2047 overdose deaths in the study, 13.5% were deemed possibly preventable, and 2.7% were found such that a business could have possibly provided naloxone. The preventable overdoses were most commonly found by a \"close contact\" (family, friend, boy/girlfriend, and room/housemate) in a residence. A targeted effort to educate and supply naloxone to people who use drugs and their close contacts offers the best chance of reducing fentanyl overdose deaths. Mandating all businesses to carry naloxone is not supported by this study.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
American Journal of Forensic Medicine and Pathology
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